Pain

1. Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 43
Pain Management

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Survival
 I will survive

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Nature of Pain
 Involves physical, emotional, and cognitive
components
 Physical and/or mental stimulus
 Is exhausting and demands energy
 Interferes with relationships

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Physiology of Pain
Transduction Transmission
Perception Modulation

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Pain is in the Brain
Pain

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Gate Control
 Nonpharmacological relief=Gate closed
 Gate open=pain transmission
 Nonpharmacological interventions

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Types of Pain
Acute/transient pain
Protective, identifiable, short
duration
Chronic/persistent
Is not productive and has no
purpose or may not have
identifiable cause
Chronic episodic
Occurs sporadically over an
extended duration
Cancer
Can be acute or chronic
Inferred physiological
Musculoskeletal, visceral, or
neuropathic
Idiopathic
Chronic pain without an
identifiable physical or
psychological cause

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Nursing Knowledge Base
 Attitude of health care providers
 Fabricator or complainer
 Assumptions about clients in pain
 Biases based on culture, education,
experiences

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Factors Influencing Pain
 Physiological
 Age, fatigue, genes, neurological function
 Social
 Attention, previous experiences, family and
support groups
 Spiritual

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Factors Influencing Pain (cont.)
 Psychological
 Anxiety, coping style
 Cultural
 Meaning of pain, ethnicity

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Nursing Process and Pain
 Pain management needs to be systematic.
 Pain management needs to include the
client’s quality of life.
 Clinical guidelines are available to manage
pain.
 American Pain Society
 National Guideline Clearing House

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Assessment
 Client’s expression of pain
 Characteristics of pain
 Onset and duration
 Intensity
 Pattern
 Contributing symptoms
 Behavioral effect

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Assessment (cont.)
 Location
 Quality
 Relief measures
 Effect of pain
 Influence on ADLs

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Diagnosis and Planning
 Focuses on the specific nature of pain
 Mandates a thorough assessment
 Selected from NANDA-I–approved list
 Interventions selected after client goals
and outcomes are identified

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Implementation
 Nonpharmacological interventions
 Relaxation and guided imagery
 Distraction
 Music
 Cutaneous stimulation
• Massage, TENS, heat, cold, acupressure
 Herbals
 Cloud

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Pharmacological Pain Relief
 Analgesics
 Nonopioids
 Opioids
 Adjuvants/coanalgesics
 PCA
 Local/regional anesthesia
 Topical agents

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Chronic Noncancer and Cancer
Pain Management
 Cancer pain either chronic or acute
 Breakthrough pain
 Transdermal and transmucosal fentanyl

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Barriers to Effective Pain
Management
 The client, health care provider, and health
care system
 Physical dependence, addiction, and drug
tolerance
 Placebos

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Pain Clinics, Palliative Care,
and Hospice
 Pain centers treat clients on an inpatient or
outpatient basis.
 The goal of palliative care is to learn how
to live life fully .
 Hospices are programs for end-of-life care.

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Evaluation
 Evaluation of pain is considered a major
responsibility of nurses.
 The client’s response to pain may not be
obvious.
 Evaluating the appropriateness of pain
medication will require nurses to evaluate
clients 15 to 30 minutes after
administration.